Study of association between use of complementary and alternative medicine and non-compliance with modern medicine in patients presenting to the emergency department.

CONTEXT: Complementary and alternative medicines (CAMs) are extensively used by the public. Noncompliance is an important cause of therapy failure. AIM: This study was done to determine prevalence of emergency admission due to noncompliance with modern medicine following switching over to CAM and to identify any significant association for CAM use among noncompliers. SETTING AND DESIGN: This cross-sectional study was conducted in the emergency unit of a tertiary healthcare institute. MATERIALS AND METHODS: Demographic factors and system affected were compared between compliers and noncompliers. Prevalence, reasons and nature of noncompliance were determined. Age, gender, outcome, relation strength and potential preventability of noncompliance, precipitating and previous disease and noncompliant drugs were compared for significant association between CAM using and other noncompliers. STATISTICAL ANALYSIS: Student's 't' test, Chi square test and odds ratio were used. RESULTS: Of the 506 patients interviewed 168 (33%) were noncompliant. In 160 (95%) patients noncompliance was due to under-dosing. Lack of knowledge and CAM use constituted 144 (86%) noncompliance-related admissions. Thirty-three (7%) admissions were strongly related to noncompliance and CAM use. Age, gender, outcome, drug use and diseases except chronic obstructive pulmonary disease (COPD) and asthma showed no association while relation strength and potential preventability of emergency admission was less with CAM-using noncompliers. Noncompliance was observed for hypertension, diabetes, COPD and asthma, seizure disorder, tuberculosis and hemophilia besides hepatic and renal failure. The CAM noncompliers used CAM more for modern medicine incurable or unaffordable than curable diseases. CONCLUSION: Advice for regular treatment and frequent monitoring can decrease CAM use-related noncompliance admissions.

Intoxicação por Solanum fastigiatum (Solanaceae) em bovinos: epidemiologia, sinais clínicos e morfometria das lesões cerebelares / Poisoning by Solanum fastigiatum (Solanaceae) in cattle: epidemiology, clinical signs and morphometry of cerebellar lesions

Dezenove casos de intoxicação por Solanum fastigiatum são descritos em bovinos de três municípios do Rio Grande do Sul no período de 2003-2005. Os coeficientes de morbidade e mortalidade foram respectivamente de 6,7 por cento e 3,4 por cento. Os bovinos afetados tinham idade média de 5 anos (2-8 anos) e a evolução clínica variou de 3-18 meses. Os sinais clínicos observados em todos os bovinos foram de disfunções cerebelares caracterizadas por hipermetria, incoordenação, quedas, tremores musculares, convulsões esporádicas e permanência em estação com os membros em base ampla. Em um bovino foi observada hemorragia traumática subdural no encéfalo e em outro, atrofia macroscópica do cerebelo. As lesões histológicas eram confinadas ao cerebelo e consistiram de vacuolização parcial ou total do pericário dos neurônios de Purkinje com ocasionais esferóides axonais na camada de células granulares e na substância branca cerebelar. Nos casos avançados, havia acentuada perda dos neurônios de Pukinje e proliferação dos astrócitos de Bergmann. O estudo morfométrico do número de neurônios de Purkinje e da espessura da camada molecular revelou um decréscimo no número de células de Purkinje que se correlacionou com conseqüente diminuição da espessura da camada molecular.

Nineteen cases of Solanum fastigiatum (Solanaceae) poisoning in cattle from three municipalites in the State of Rio Grande do Sul, Brazil, occurring from 2003 to 2005, are described. Morbidity and mortality rates were respectively 6.7 percent and 3.4 percent. Average age of affected cattle was five-year-old (2 to 8-year-old) and duration of clinical courses was 3-18 months. Clinical signs observed in all affected cattle were cerebellar deficits characterized by hypermetry, incoordination, falls, muscle tremors, transitory seizures and wide base stance. One affected bovine had encephalic traumatic subdural hemorrhage and another had gross atrophy of the cerebellum. Histologically, lesions were restricted to the cerebellum and consisted of partial or complete vacuolation of the perikaria of Purkinje neurons with occasional axonal spheroids in the granular cell layer and in the white matter of the cerebellum. In advanced cases there were extensive loss of cerebellar Purkinje neurons and proliferation of the Bergmann's glia. The morphometric evaluation of the numbers of Purkinje neurons and of the thickness of the cerebellar molecular layer indicated decreased numbers of Purkinje neurons with consequent decrease in the molecular layer thickness.